In vitro production of bilirubin photoisomers by light irradiation using neoBLUE

BACKGROUND: The light-emitting diode is used as one of the new light sources for phototherapy. NeoBLUE (Atom Medical, Tokyo, Japan) incorporates blue light-emitting diodes for the treatment of neonatal hyperbilirubinemia. The authors compared the in vitro efficacy of neoBLUE with conventional phototherapy devices. METHODS: The three light devices used included neoBLUE and two conventional phototherapy devices with six blue-white (BW) or six green (GR) fluorescent tubes. A bilirubin/human serum albumin solution (15 mg/dL) in 200 x 300 mm elliptical bag was irradiated with each three light device. The average light intensity of neoBLUE, BW and GR was 22.5, 10.2 and 2.6 microW/cm(2) per nm, respectively, for the irradiated area. Bilirubin photoisomers and native bilirubin were measured by high-performance liquid chromatography. RESULTS: In neoBLUE, BW and GR, the respective production rate of cyclobilirubin was 6.0, 3.7 and 3.9 x 10(-2) mg/dL/min, and the respective (4Z, 15E)-bilirubin/(4Z, 15Z)-bilirubin ratio after irradiation was 0.44, 0.33 and 0.12; the (4Z, 15Z)-bilirubin reduction rate at 20 min after irradiation was 60, 68 and 82%, respectively. The reduction rate of (4Z, 15Z)-bilirubin correlated with the (4Z, 15E)-bilirubin/(4Z, 15Z)-bilirubin ratio. CONCLUSION: Phototherapy using the neoBLUE under high level may be clinically more effective than therapy using the conventional light source from the results of the production rate of cyclobilirubin.     

Two monoclonal antibodies detecting allotypic determinants of HLA-A

Three mouse hybridomas producing cytotoxic antibodies against HLA were established. By standard microcytotoxicity test against panels of normal controls, the antigen defined by MA-9 antibody (IgM) showed a good correlation with HLA-A9 alloantigen detected by conventional typing alloantisera (r = 1.0). Family studies also showed that MA-9 determinant segregated with HLA-A9. MA-10 antibody (IgM) reacted with all HLA-A10 positive lymphocyte donors and cross-reacted with two thirds of HLA-AW33 positive donors. M1-1 antibody (IgG2a) reacted with all the panel cells tested and immunoprecipitated a molecule of 43,000 daltons from Nonidet P-40 lysates of ³H-glucosamine-labelled cells. The results showed that MA-9 and MA-10 antibodies can be used as routine tissue typing reagents.     

CUTANEOUS MALIGNANT LYMPHOMAS

Clinical and histological findings in 37 cases of cutaneous lymphomas other than mycosis fungoides and Sezary syndrome were investigated; there were 31 in adults and 6 in children. Cutaneous lesions were the first manifestations of the diseases in all cases, and they appeared mostly as tumors or nodules. Cytomorphologically, about a half of the cases showed proliferations of large cleaved, non-cleaved cells or immunoblasts (Group I). Eight cases showed a polymorphous appearance containing convoluted cells of various size (Group II). Five cases in children demonstrated monomorphous proliferation of uniform-sized lymphoblasts (Group III). The cytologic findings in 6 cases did not fit into any lymphoid groups (Group IV). The clinical findings observed in each group were reviewed and compared. Follow-up study revealed that the prognosis of Group I was the poorest among the four groups.     

Growth-inhibitory effects of 1,25-dihydroxyvitamin D3 on normal and psoriatic keratinocytes

The effects of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) on the growth and DNA synthesis of cultured human keratinocytes obtained from involved and uninvolved psoriatic epidermis and normal epidermis were studied. Treatment with 10(-8) M and 10(-7) M of 1,25(OH)2D3 inhibited cell growth as follows: 58.5 +/- 19.3% and 21.3 +/- 13.6% in normal keratinocytes (n = 6); 43.8 +/- 22.8% and 17.8 +/- 12.3% in psoriatic uninvolved keratinocytes (n = 4); 51.7 +/- 18.2% and 13.2 +/- 6.4% in psoriatic involved keratinocytes (n = 6). Inhibition was virtually complete at 10(-6) M. DNA synthesis was also inhibited by 10(-8) M, 10(-7) M and 10(-6) M of 1,25(OH)2D3 as follows: 70.0 +/- 8.3%, 59.0 +/- 6.8% and 16.7 +/- 4.0%, respectively, in normal keratinocytes (n = 3); 78.5 +/- 13.5%, 51.5 +/- 25.5% and 24.5 +/- 21.5%, respectively, in psoriatic uninvolved keratinocytes (n = 2); and 69.3 +/- 14.5%, 41.3 +/- 19.1% and 14.8 +/- 11.2%, respectively, in psoriatic involved keratinocytes (n = 4). These results indicate that 1,25(OH)2D3 functions as a growth inhibitor for cultured human keratinocytes derived from both normal and psoriatic skin.     

Skin pigmentation associated with minocycline therapy

A patient on long-term minocycline therapy developed blue-black discoloration on the legs. Skin biopsy specimens from the pigmented areas were examined by light and electron microscopy and energy-dispersive X-ray microanalysis. Pigmented granules were present at all levels of the dermis and subcutaneous fat tissues. Ultrastructural examination showed electron-dense granular material within the cytoplasm of dermal macrophages and energy-dispersive X-ray microanalysis indicated that the granules contained iron. Thyroid tissue obtained by aspiration biopsy showed the presence of fine brown granules within the cytoplasm of the follicular epithelial cells. An extract of skin from the pigmented areas was subjected to high performance liquid chromatography and minocycline was detected.     

Proteus syndrome with giant myelolipoma in the pelvis

Proteus syndrome is a very rare and complex disorder with malformations and overgrowth of multiple tissues. This disorder was designated Proteus syndrome by Wiedemann et al. to denote its variable clinical expression. Our patient presented with macrodactyly, cerebriform appearance and a huge abdominal mass. A biopsy under laparotomy was performed, and histopathological examination revealed myelolipoma. Tumor resection was performed. To our knowledge, no case of Proteus syndrome presenting a myelolipoma in the retroperitoneal cavity has been reported before.     

Periventricular leukomalacia associated with hypocarbia

We here report a case of periventricular leukomalacia (PVL) associated with hypocarbia which remained even after extubation. The patient had no risk factors affecting PVL development other than hypocarbia. We consider that the irregular tachypnea which remained after extubation might be attributable to overdriving of ventilation of central neurogenic origin. Our patient's clinical course suggests that sodium bicarbonate drip infusion is a very effective way to alter the set point of respiratory neuronal drive of the patient with central neurogenic hyperventilation.     

Characterization of anti-histone antibodies in patients with type 1 autoimmune hepatitis

We have recently found that antibodies to total histones are common in a group of American patients with type 1 autoimmune hepatitis (AIH). In an attempt to determine the profile and clinical association of anti-histone antibody (AHA), 45 Japanese AIH patients were studied for serum isotypic reactivity with individual histones (H1, H2A, H2B, H3, H4) by enzyme-linked immunosorbent assay and western blotting. The results revealed that 40% of sera had reactivities with at least one of individual histones and that the antibodies were detected in all three classes of immunoglobulins (IgG, IgM, IgA). Immunoglobulin G type anti-H3 showed the dominant reactivity and it characterized 72% of sera with AHA. The titre of anti-H3 decreased significantly ( P < 0.0075) after steroid therapy and the index of decrease for anti-H3 was correlated in individuals with that for serum aminotransferase. In general, patients with AHA showed higher serum level of alanine aminotransferase ( P < 0.05), immunoglobulin G ( P < 0.025), and higher frequency of A2-DR4 haplotype (53 vs 17%) than their seronegative counterparts. However, the titre of AHA was low in this disease condition and histone class-specific antibodies did not distinguish patients with distinctive clinical features, although patients with anti-H3 tended to be younger than those without AHA.